CEAL-SM / SUSESO

Work Environment Assessment Questionnaire – Mental Health / SUSESO

I. General section
Demographics (DD)
DD1. What gender do you identify with?
1 Male
2 Female
3 Other
4 I prefer not to answer

DD2. How old are you?

_____ years

Work and current employment (TEA)

TEA1. In what geographic unit (branch, floor, region, etc.) do you work? [list of units considered]

TEA2 What is your occupation? (Occupation is the work that you actually do in your job, regardless of your educational
level; example: a person has technical training but performs administrative or unqualified work). (list of ISCO occupations)

TEA3. In which department, unit or section do you work? (list of departments, units, etc.)

TEA4. At your job, do you have to telework? (work from home using an electronic device, such as a notebook or
computer)
0 no
1 Yes, but most of the week I do face-to-face work
2 Yes, half the time teleworking, half the time face-to-face
3 Yes, most of the week I telework
4 Yes, the whole week teleworking

TEA5. Approximately, how much is your net monthly salary? (what you receive after health and pension discounts
applied)
1 Less than or equal to $140,000
2 $140,001 - $280,000
3 $280,001- $550,000
4 $550,001 - $830,000
5 $830,001 - $1,100,000
6 $1,100,001 - $1,400,000
7 $1,400,001 - $2,000,000
8 $2,000,001 and more

TEA6. Your salary is

1 Fixed
2 Base salary plus commissions or variable
3 Variable only

Unidad de Prevención y Vigilancia / Intendencia de Seguridad y Salud en el Trabajo

Superintendencia de Seguridad Social
TEA7. In the last year, have you had two or more bosses or supervisors at the same time?
0 No
1 Yes

TEA8. Your working day is:

1. full ordinary
2. partial ordinary
3. excepted from fixed working schedule (article 22)
4. other

TEA9. Your working hours are:

1 daytime schedule (morning and/or afternoon)
2 fixed night shifts
5 rotating shifts

TEA10. The distribution of your working days are:

1 from Monday to Friday
2 from Monday to Saturday
3 only weekends or holidays
4 Monday to Friday and sometimes Saturday, Sunday and holidays
5 other

TEA11. Indicate how many hours you worked for the company or institution last week:
____ hours per week

TEA12. If in the previous question you wrote down less than 45 hours or 44 for the public sector, indicate the reason. If you
wrote down more than 45 hours or 44 for the public sector, check the first alternative.
0 Last week I worked 45 (44) hours or more
1 I have a part-time job for this company or institution
2 I have an irregular distribution of my working day (I don't always work the same hours)
3 My working day is exceptional (42 hour cycle)
4 I have been on vacation, sick or on leave
5 Other motives

TEA13. What kind of employment relationship do you have with your company or institution?
1 permanent contract or plant position
2 temporary contract or contract position
3 contract for tasks or projects
4 contract by external institution or company
5 fee contract
6 student in practice

TEA14. Taking everything into account, how satisfied are you with your current job?
0 very satisfied
1 satisfied
2 neutral
3 dissatisfied

Unidad de Prevención y Vigilancia / Intendencia de Seguridad y Salud en el Trabajo

Superintendencia de Seguridad Social
 4 very dissatisfied

Personal health and wellness

The next 12 questions ask about how you have been feeling in the past FEW weeks.

GHQ1. Have you been able to concentrate well on whatever you were doing?
1 better than usual
2 same as usual
3 less than usual
4 much less than usual

GHQ2. Have you lost much sleep because of worry?

1 not at all
2 no more than usual
3 rather more than usual
4 much more than usual

GHQ3. Have you felt that you are playing a useful role in life?
1 more so than usual
2 same as usual
3 less so than usual
4 much less than usual

GHQ4. Have you felt capable of making decisions?

1 more so than usual
2 same as usual
3 less so than usual
4 much less than usual

GHQ5. Have you felt constantly under strain?

1 not at all
2 no more than usual
3 rather more than usual
4 much more than usual

GHQ6. Have you felt you could not overcome your difficulties?
1 not at all
2 no more than usual
3 rather more than usual
4 much more than usual

GHQ7. Have you been able to enjoy your normal day-to-day activities?
1 more so than usual
2 same as usual
3 less so than usual
4 much less than usual

Unidad de Prevención y Vigilancia / Intendencia de Seguridad y Salud en el Trabajo

Superintendencia de Seguridad Social
GHQ8. Have you been able to face up to your problems?
1 more so than usual
2 same as usual
3 less so than usual
4 much less than usual

GHQ9. Have you been feeling unhappy and depressed?

1 not at all
2 no more than usual
3 rather more than usual
4 much more than usual

GHQ10. Have you been losing confidence in yourself?

1 not at all
2 no more than usual
3 rather more than usual
4 much more than usual

GHQ11. Have you been thinking of yourself as a worthless person?

1 not at all
2 no more than usual
3 rather more than usual
4 much more than usual

GHQ12. All things considered, have you been feeling reasonably happy?
1 more so than usual
2 same as usual
3 less so than usual
4 much less than usual

DL1 How much bodily pain have you had during the past 4 weeks?
0 none
1 very mild
2 mild
3 moderate
4 severe
5 very severe

DL2 During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the
home and housework)?
0 not at all
1 a little bit
2 moderately
3 quite a bit
4 extremely

Unidad de Prevención y Vigilancia / Intendencia de Seguridad y Salud en el Trabajo

Superintendencia de Seguridad Social
AT1. In the last 12 months, have you had an accident that corresponds to a work accident? Consider as a work accident any
blow, fall, wound, cut, fracture, burn, poisoning or other that occurred at work or because of it. Do not consider
commuting accidents.
0 No
1 Yes

EP1. In the last 12 months, have you had any illness that you think was caused by work?
0 No
1 Yes

LM1. In the last 12 months, how many total sick leaves have you had? (except prenatal and postnatal medical leave, and
leave for serious illness of a child under 1 year of age)
0 I have not had any sick leave in the last year
1 Approximately, I have had _____ sick leaves in the last year

LM4. In the last 12 months, how many total days have you been on sick leave? (except prenatal and postnatal medical
leave, and leave for serious illness of a child under 1 year of age). If you answered NO to the previous question, please
check the first alternative.
0 I have not had any sick leave in the last year
1 Approximately, I have had ________ days of sick leave in the last year

II. Specific section of psychosocial risk

Below, you will find a series of questions about the contents and demands of your job. Please answer ALL the questions
and choose ONLY ONE ANSWER for each of them. Remember that there are no right or wrong answers. Thank you so
much.
Never /
Some
Cod Item Always Often Seldom almost
times
never

QD1 Is your workload unevenly distributed so it piles up?

QD2 How often do you not have time to complete all your work tasks?

QD3 Do you get behind with your work?

ED1 Does your work put you in emotionally disturbing situations?

Do you have to deal with other people’s (clients, customers)

ED2
personal problems as part of your work?

HE2 Does your work require that you hide your feelings?

Do you have the possibility of learning new things through your

DP2
work?

DP3 Can you use your skills or expertise in your work?

Unidad de Prevención y Vigilancia / Intendencia de Seguridad y Salud en el Trabajo

Superintendencia de Seguridad Social
 DP4 Does your work give you the opportunity to develop your skills?

MW1 Is your work meaningful?

Do you receive all the information you need in order to do your

PR2
work well?

RE1 Is your work recognized and appreciated by the management?

RE2 Does the management at your workplace respect you?

RE3 Are you treated fairly at your workplace?

CL1 Does your work have clear objectives?

CL2 Do you know exactly which areas are your responsibility?

CL3 Do you know exactly what is expected of you at work?

Never /
Some
Cod Item Always Often Seldom almost
times
never

CO2 Are contradictory demands placed on you at work?

Do you sometimes have to do things which ought to have

CO3
been done in a different way?

Do you sometimes have to do things which seem to be

IT1
unnecessary?

Would you say that your immediate superior is good at work

QL3
planning?

Would you say that your immediate superior is good at

QL4
solving conflicts?

How often is your immediate superior willing to listen to your

SS1
problems at work, if needed?

How often do you get help and support from your immediate
SS2
superior, if needed?

Never /
Some I don´t have
Cod Item Always Often Seldom almost
coworkers
times
never

How often do you get help and support from your

SC1
colleagues, if needed?

Unidad de Prevención y Vigilancia / Intendencia de Seguridad y Salud en el Trabajo

Superintendencia de Seguridad Social
 How often are your colleagues willing to listen to
SC2
your problems at work, if needed?

Is there a good atmosphere between you and your

SW1
colleagues?

Do you feel part of a community at your place of

SW3
work?

Never /
Some
Cod Pregunta Always Often Seldom almost
times
never

Are you worried about your working tasks being changed against
IW1
your will?

Are you worried about being transferred to another workplace, job,

IW2
function, unit, department or section against your will?

Are you worried that your schedule (shifts, days of the week, start
IW3
and end times) will be changed against your will?

Do you feel that your work drains so much of your ENERGY that it
WF2
has a negative effect on your private life?

Do you feel that your work takes so much of your TIME that it has
WF3
a negative effect on your private life?

Do the demands of your job interfere with your private and family
WF5
life?

TE1 Do the employees in general trust each other?

TM1 Does the management trust the employees to do their work well?

Never /
Some
Cod Item Always Often Seldom almost
times
never

Do workers trust the information that comes from managers,

TM2
directors or employers?

TM4 Can workers express their opinions and feelings?

JU1 In your work, are conflicts resolved in a fair way?

JU2 Are employees valued when they have done a good job?

JU4 Is the work distributed fairly?

Please note when answering the following questions that they have somewhat different answers.

Unidad de Prevención y Vigilancia / Intendencia de Seguridad y Salud en el Trabajo

Superintendencia de Seguridad Social
 Almost
Cod Item Never Seldom Always
always

VU1 Are you afraid to ask for better working conditions?

Do you feel defenseless in the face of unfair treatment from your

VU2
superiors?

VU3 Are you afraid of being fired if you don't do what they ask?

Do you consider that your superiors treat you in a discriminatory or

VU4
unfair way?

VU5 Do you consider that you are treated in an authoritarian or violent way?

VU6 Do they make you feel that you can be easily replaced?

Yes, a few Yes, Yes, Yes,

N° Item No
times monthly weekly daily

Have you been involved in quarrels or conflicts at your workplace

CQ1
during the last 12 months?

Have you been exposed to unpleasant teasing at your workplace

UT1
during the last 12 months?

Have you been exposed to work-related harassment on the social

HSM1 media (e.g. Facebook), by e-mail or text messages during the last
12 months?

Have you been exposed to undesired sexual attention at your

SH1
workplace during the last 12 months?

Have you been exposed to physical violence at your workplace

PV1
during the last 12 months?

Bullying means that a person repeatedly is exposed to unpleasant or

degrading treatment, and that the person finds it difficult to defend
AL
himself or herself against it. Have you been exposed to bullying at
your workplace during the last 12 months?

How often do you feel unjustly criticised, bullied or shown up in front

HO
of others by your colleagues or your superior?

Unidad de Prevención y Vigilancia / Intendencia de Seguridad y Salud en el Trabajo

Superintendencia de Seguridad Social